TEMPLATE FOR SIX MONTHLY DISTRICT/SUB-DISTRICT CLINICAL PERFORMANCE REVIEW REPORT

Table of contents

1. Introduction......................................................................................................................................................................32. Mortality reports...............................................................................................................................................................3

2.1 Maternal deaths........................................................................................................................................................ 32.2 Neonatal deaths (include still births).........................................................................................................................42.3 Under-five year’s death (will include neonatal deaths)..............................................................................................5

3. Output indicators for quality of clinical care.....................................................................................................................64. Patient safety incidents................................................................................................................................................... 7

4.2 Classification according to type of incident...................................................................................................................84.3 Patient outcome......................................................................................................................................................... 10

5. Complaints.................................................................................................................................................................... 116. Clinical audits................................................................................................................................................................ 12

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Abbreviations:

DHIS: District health information system

iMMR: Maternal mortality ratio

iNNMR: Neonatal mortality ratioiSBR: Stillbirth ratio

PIPP: Perinatal Problem Identification Programme

CHIP: Child Healthcare Problem Identification Programme

MDNF: Maternal Death Notification Form

A&E: Accident and Emergency

SAM: Sever Acute Malnutrition

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1. Introduction

This template gives guidance to sub-district/district clinical review teams to identify gaps in clinical care provided to patients receiving treatment in

primary health care facilities. Four types of data are used to assess clinical care in this report:

mortality reports,

output indicators for quality of clinical care,

patient safety incidents

complaints

clinical audits

Districts should collate the data for their district in the templates provided. A section is provided at the end of each set of data to make findings and

recommendations. Note if the data is available in other already existing reports the reports can be attached as annexures but findings and

recommendations should be made every six month on the data as set out in this template.

2. Mortality reports

2.1 Maternal deathsApril to Sept Oct to Mar

Tot Fin Year

CH

C 1

CH

C 2

CH

C 3

CH

C 4

CH

C 5

CH

C 6

CH

C 7 TOT

CH

C 1

CH

C 2

CH

C 3

CH

C 4

CH

C 5

CH

C 6

CH

C 7

TOT

Numerator (number of deaths) (from DHIS

Target limits (disaggregated/allocated from APP)

Denominator (live births) (from DHIS)

Case fatality Rates (from DHSI) ( iMMR)

Clinical analysis - from death review programmes (PPIP, CHIP)Causes of death (top 5, ranked) (From PPIP, MDNF)

CD Case Fatality Rates

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Modifiable factors (from MDNF): most common factors by place of occurrence (home, clinic, hospital A&E, ward) for

Clinical providers Administrative /managers Patient/ family / community

Numbers/proportions and description from MDNF, PPIP)

Referral system analysis# referrals who died (“transfer deaths”. NB not added twice in totals) # deaths in transit (EMS)

2.2 Neonatal and perinatal deaths

April to Sept Oct to Mar

Tot Fin Year

CH

C 1

CH

C 2

CH

C 3

CH

C 4

CH

C 5

CH

C 6

CH

C 7 TOT

CH

C 1

CH

C 2

CH

C 3

CH

C 4

CH

C 5

CH

C 6

CH

C 7

TOT

Numerator (number of neonatal deaths) ( DHIS)

Of Which early/late

Target limits neonatal deaths (disaggregated/allocated from APP)

Number of Stillbirths

Denominator (number of live births) (DHIS)

Case fatality Rates - iNNMR (DHIS)

Case fatality Rates - iSBR (DHIS)

Clinical analysis - from death review programmes (PPIP, CHIP)Causes of death (top 5) (from PPIP)

Deaths by weight: >250g (# & %)

Deaths by weight: 1000 – 2500g (# & %)

Deaths by weight: <1000g (# & %)Modifiable factors most common factors by place

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of occurrence (home, clinic, hospital A&E) for Clinical providers Administrative Patient/family/community

Numbers/proportions & description from PPIP

Referral system analysis# referrals who died (“transfer deaths”. NB not added twice in totals) # deaths in transit

Recommendations: First 6 monthsMonitoring cycle: Responsive plan and implementation in response to review (modifiable factors and actions) Commonest modifiable factors listedRoot cause analysis of modifiable factors to determine action and responsibility

Role/ Place of occurrence

Caregiver / patient Administrator / manager Clinical personnel / provider

Factor Action, responsibility Factor Action,

responsibility Factor Action, responsibility

Home

Clinic

CHC

Recommendations: Last 6 monthsMonitoring cycle: Responsive plan and implementation in response to review (modifiable factors and actions) Commonest modifiable factors listedRoot cause analysis of modifiable factors to determine action and responsibility

Role/ Place of occurrence

Caregiver / patient Administrator / manager Clinical personnel / provider

Factor Action, Factor Action, Factor Action,

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responsibility responsibility responsibility

Home

Clinic

CHC

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Caregiver / patient Administrator / manager Clinical personnel / provider

Factor Action, responsibility Factor Action, responsibility Factor Action, responsibility

2.3 Under-five year’s death (will include neonatal deaths) Quarter 1 Quarter 2 Tot : Q1 + Q2 Quarter 3 Quarter 4 Tot: Q3 + Q4 Tot Fin Year

Numerator (number of deaths from DHIS

Denominator (number admissions (from DHIS)

Specific mortality markers (# and % with SAM)Case fatality Rates (from DHSI) Under-five institutional death rates

Target limits (disaggregated/allocated from APP)

# Deaths from specific diseases:

DD

Pneumonia

SAM

# admissions from specific diseases

DD

Pneumonia

SAM

Case Fatality Rates (CFR) or these diseases

CLINICAL ANALYSISCauses of death (top 5) (from CHIP)Modifiable factors most common factors by place of occurrence (home, clinic, hospital A&E) for

Clinical providers Administrative Patient/family/community

Numbers/proportions and description (from CHIP)

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For referrals in (at next level)Referring institutions (list ranked by # of referred cases)# deaths in cases referred (transfer deaths” for referring institution – NB not counted in totals)

FINDINGS AND RECOMMENDATIONSFindings

Recommendations

3. Output indicators for quality of clinical care

Indicator Quarter 1 Quarter 2 Tot : Q1 + Q2 Quarter 3 Quarter 4 Tot: Q3 + Q4 Tot Fin Year

TB treatment success rate is at least 85% or has increased by at least 5% from the previous year

TB (new pulmonary) defaulter rate < 5%Antenatal visit rate before 20 weeks gestation is at least 67% or has increased by at least 5% from the previous yearAntenatal patient initiated on ART rate is at least 96% or has increased by at least 5% from the previous yearImmunisation coverage under one year (annualised) is at least 87% or has increased by at least 5% from the

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previous yearFINDINGS AND RECOMMENDATIONS

Findings

Recommendations

4.Patient safety incidents4.1 Indicators

Month:Quarter 1 Quarter 2 Tot : Q1 + Q2 Quarter 3 Quarter 4 Tot: Q3 + Q4 Tot Fin Year

A # PSI cases

B #PSI cases closed

C % PSI cases closed (Column B/ Column A)

D # PSI cases closed within 60 working days

E % of PSI cases closed within 60 working days (Column D/ Column B)

F # PSI SAC 1

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G # SAC 1 incidents reported within 24 hours

H %of SAC 1 incidents reported within 24 hours (Column F/ Column G)

Findings

Recommendations

4.2 Classification according to type of incident

TypeQuarter 1 Quarter 2 Tot : Q1 +

Q2Quarter 3 Quarter 4 Tot: Q3 +

Q4Tot Fin

Year AV

G % *

1.Clinical administrationMedical procedure performed without consent2. Clinical process/ procedureNot performed when indicatedPerformed on wrong patientWrong process/ procedure/ treatment performedPerformed on wrong body part/ site/ sideRetention of foreign object during surgeryPressure sores acquired during admissionMaternal deathNeonatal deathFresh still born

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3. Health care-associated infectionsCentral line associated blood stream infectionPeripheral line infectionSurgical siteHospital acquired pneumoniaVentilator associated pneumoniaCatheter associated urinary tract infectionCommunicable diseases4. Medication/ IV fluidsWrong dispensing Omitted medicine or doseMedicine not availableAdverse drug reactionWrong medicine Wrong dose/ strength administeredWrong patientWrong frequencyWrong routePrescription error5. Blood or blood productsAcute transfusion reactionsDelayed transfusion reactions/ events (including transfusion transmitted infections)Errors- wrong blood/ blood products6. Medical devises/ equipment/ propertyLack of availabilityFailure / malfunction7. BehaviourSuicideAttempted suicideSelf inflicted injurySexual assault by staffSexual assault by fellow patient or visitorPhysical Assault by staffPhysical assault by fellow patient or visitorExploitation, abuse, neglect or degrading treatment by fellow patient or visitorExploitation, abuse, neglect or degrading

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treatment by staff memberWandering/abscondingRefusal of treatment8. Patient accidentsFalls9. Infrastructure/ Buildings/ fixturesDamaged/ faulty/ wornNon-existent/ Inadequate10. OtherAny other incident that does not fit into category 1 to 9GRAND TOTALList Top 5 categories

Findings

Recommendations

4.3 Patient outcome

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Quarter 1 Quarter 2 Tot : Q1 + Q2

Quarter 3 Quarter 4 Tot: Q3 + Q4

Tot Fin Year

AVG

% *

NoneMildModerateSevereDeathGRAND TOTAL

Findings and recommendationsFindings

Recommendations

5. ComplaintsComplaints category Quarter 1 Quarter 2 Tot : Q1 +

Q2Quarter 3 Quarter 4 Tot: Q3 +

Q4Tot Fin

Year

AVG

% *

Patient careHygiene and cleanlinessAvailability of medicinesPhysical accessGRAND TOTAL

Findings and recommendationsFindings

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Recommendations

6. Clinical audits

Priority areas Quarter 1 Quarter 2 Tot : Q1 + Q2

Quarter 3 Quarter 4 Tot: Q3 + Q4

Tot Fin Year

AVG

HIV/TB

Non communicable diseases (diabetes and hypertension)Maternal (ANC and PNC)

Well baby

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Sick child (IMCI)

Findings and recommendations

Findings

Recommendations

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